I will try and save your life after a coward punch

I AM a trauma surgeon and along with a team of experts at St Vincent’s Hospital, everyday – especially on weekends – our emergency department is like a zoo. But unlike a zoo, some people will die needlessly with their lives cut short.

Some are still teenagers. Mostly boys or young men.

More people in Sydney are flocking to partying hot spots, such as Kings Cross, Oxford St and parts of Surry Hills. This means that there is a greater concentrations of people with high levels of drinking.

Other major cities around the country have similar hot spots and pressures. This is not just a Sydney problem but also a national problem.

While stimulant drugs play a role in adding to dangers, alcohol is without question a massive problem leading to violence and death. Recently it has become much worse.

With greater accessibility to steroids and other body-building supplements, the cocktail is formidable. Add to how young people sometimes “pre-load” by drinking at home first to save money, it can only be expected that I will see some of you limp and lifeless in the operating room of St Vincent’s.

“King hit” or “coward punch” are being used to describe what is a far more complex issue. There are two major factors that cause the really serious brain injuries. It is usually not the initial punch or blow, as the face and skull can adequately protect the brain from a punch – even a so-called king hit.

However, if that punch renders someone unconscious, then it is the uncontrolled fall from the standing position and the head hitting the concrete or gutter that is where the serious brain injuries occur.

This causes skull fractures, bleeding inside the brain and raised pressure inside that boney skull. The blood supply is reduced to fight against this pressure. The brain is very delicate and this is enough to cause irreversible brain injuries.

Witnesses report a body going limp then a sickening crack, leaving no doubt that this is a serious head injury. You would think that would be enough to stop an attacker – but the other area of brain injury we are seeing is from continued attacks, such as beatings.

When on the ground, victims are being stomped on their heads by attackers, kicking and continuing to punch. So even if the first punch and fall didn’t cause irreversible brain damage, the savage continuation when someone is unconscious or semi-conscious does.

Some people die from this – all while out to have a good time.

The victim is a punching bag. It is a very concerning phenomenon that assaults continue while someone lays on the ground unconscious.

When someone arrives by ambulance or helicopter from the outer-suburbs or regions, we will have already started preparations for immediate surgery that may include opening the victim’s skull and removing a large part of the bone to relieve the pressure. If there is any bleeding either within the brain or around the brain, then this blood clot also needs to be removed to relieve the pressure on the brain itself.

The bone removed from the skull is usually not put back in place. This allows the injured brain to expand and swell without causing further brain injury. We can replace the bone back into the skull at a later date once the swelling has subsided.

A king hit that renders someone unconscious can change their life, their family’s life and their assailant’s life forever, in what may have been from an alcohol, drug and/or steroid-fuelled rush of blood. Beating down on a lifeless person is something harder to fathom.

Take care of yourself and each other. If you identify rage episodes when under the influence, when sober take the time to consider whether recreational alcohol or drug use or the perfect gym-fit body is worth it.

But if the worst happens, we will do everything we can to save the victim of an alcohol-fuelled assault.

Dr Anthony Chambers is a trauma surgeon at St Vincent’s Hospital at Darlinghurst in Sydney. His website is here.

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Scott Weber from the Police Association of New South Wales’ opinion pieceis here.

John Green from the Australian Hotels Association New South Wales opinion pieceis here.